Healthcare Provider Details

I. General information

NPI: 1285174995
Provider Name (Legal Business Name): LUIS SANCHEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2017
Last Update Date: 10/21/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 NE 102ND AVE
PORTLAND OR
97220-4166
US

IV. Provider business mailing address

21600 OXNARD ST. SUITE 1800
WOODLAND HILLS CA
91367
US

V. Phone/Fax

Practice location:
  • Phone: 503-254-6317
  • Fax: 360-326-9195
Mailing address:
  • Phone: 818-345-2345
  • Fax: 818-758-8015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberABA-AB-10175646
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number10175646
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: